Pre‐procedure

ActionRationale

1. 1.Show
   Check that all the equipment required for the procedure is available and, where applicable, is sterile (i.e. that packaging is undamaged, intact and dry, and that sterility indicators are present on any sterilized items and have changed colour where applicable).
   To ensure that the patient is not disturbed unnecessarily if items are not available and to avoid unnecessary delays during the procedure. E

   To ensure that only sterile products are used (MHRA [78], C).
2. 2.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [86], C).

Procedure

1. 3.Show
   Clean hands with an alcohol‐based handrub or wash with soap and water and dry with paper towels.
   Hands must be cleaned before and after every patient contact and before commencing the preparations for aseptic technique, to prevent cross‐infection (NHS England and NHSI [82], C).
2. 4.Show
   Clean the trolley with detergent and water or detergent wipes and dry it with a paper towel. Clean from the top surface and work down to the bottom. If disinfection is also required, use disposable wipes saturated with 70% isopropyl alcohol and allow to dry.
   Shared pieces of equipment used in the delivery of patient care must be cleaned and decontaminated after each use with products recommended by the manufacturer (Loveday et al. [73]). E

   To provide a clean working surface (Fraise and Bradley [41], E).

   Alcohol is an effective and fast‐acting disinfectant that will dry quickly (Fraise and Bradley [41], E).
3. 5.Show
   Place all the equipment required for the procedure on the bottom shelf of the clean dressing trolley.
   To maintain the top shelf as a clean working surface. E
4. 6.Show
   Take the patient to the treatment room or screen the bed. Ensure that any fans in the area are turned off and windows closed. Position the patient comfortably and so that the area to be dealt with is easily accessible without exposing the patient unduly.
   To allow any airborne organisms to settle before the sterile field (and, in this case, the wound) is exposed. To maintain the patient's dignity and comfort. E
5. 7.Show
   Put on a disposable plastic apron.
   To reduce the risk of contaminating clothing and of contaminating the wound or any sterile items via clothing. E
6. 8.Show
   Take the trolley to the treatment room or patient's bedside, disturbing the curtains as little as possible.
   To minimize airborne contamination. E
7. 9.Show
   Loosen the adhesive or tape on the existing dressing.
   To make it easier to remove the dressing. E
8. 10.Show
   Clean hands with an alcohol‐based handrub.
   Hands should be cleaned before any aseptic procedure (WHO [124], C).

   Using alcohol‐based handrub avoids having to leave the patient to go to a sink. E
9. 11.Show
   Verify that the sterile pack is the correct way up and open the outer cover. Slide the contents, without touching them, onto the top shelf of the trolley.
   To minimize contamination of the contents. E
10. 12.Show
    Open the sterile field using only the corners of the paper.
    So that areas of potential contamination are kept to a minimum. E
11. 13.Show
    Open any other packs, tipping their contents gently onto the centre of the sterile field.
    To prepare the equipment and, in the case of a wound dressing, reduce the amount of time that the wound is uncovered. E
12. 14.Show
    Where appropriate, loosen the old dressing.
    To minimize trauma when removing the old dressing. E
13. 15.Show
    Clean hands with an alcohol‐based handrub.
    Hands may have become contaminated by handling outer packets or the old dressing (NHS England and NHSI [82], C).
14. 16.Show
    Carefully lift the plastic disposal bag from the sterile field by its open end and, holding it by one edge of the open end, place your other hand in the bag. Using it as a sterile ‘glove’, arrange the contents of the dressing pack and any other sterile items on the sterile field.
    To maintain the sterility of the items required for the procedure while arranging them so as to perform the procedure quickly and efficiently. E
15. 17.Show
    With your hand still enclosed within the disposal bag, remove the old dressing from the wound. Invert the bag so that the dressing is contained within it and stick it to the trolley below the top shelf. This is now the disposal bag for the remainder of the procedure for any waste other than sharps.
    To minimize the risk of contamination by containing the dressing in the bag. E

    To ensure that any waste can be disposed of without contaminating the sterile field. E
16. 18.Show
    Pour any required solutions into gallipots or onto the indented plastic tray.
    To minimize the risk of contamination of solutions. E
17. 19.Show
    Put on gloves, as described in Procedure guideline 4.5: Putting on and removing non‐sterile gloves or Procedure guideline 4.10: Donning sterile gloves: open technique. The procedure will dictate whether the gloves should be sterile or non‐sterile.
    Gloves should be worn whenever any contact with body fluids is anticipated (Loveday et al. [73], C).

    Sterile gloves provide greater sensitivity than forceps for procedures that cannot be carried out with a non‐touch technique and are less likely to cause trauma to the patient. E
18. 20.Show
    Carry out the relevant procedure according to local guidelines.
     

Post‐procedure

1. 21.Show
   Make sure the patient is comfortable.
   To minimize the risk of causing the patient distress or discomfort. E
2. 22.Show
   Dispose of waste, including apron and gloves, in offensive waste bags.
   To prevent environmental contamination (DH [25], C).
3. 23.Show
   Draw back the curtains or help the patient back to the bed area and ensure that they are comfortable.
   To minimize the risk of causing the patient distress or discomfort. E
4. 24.Show
   Check that the trolley remains dry and physically clean. If necessary, wash it with liquid detergent and water or detergent wipe and dry thoroughly with a paper towel.
   To remove any contamination on the trolley and so minimize the risk of transferring any contamination elsewhere in the ward (Loveday et al. [73], C).
5. 25.Show
   Clean hands with alcohol‐based handrub or soap and water.
   Hands should be cleaned after any contact with the patient or body fluids (WHO [124], C).
6. 26.Show
   Document the procedure clearly, including details of who carried it out, any devices or dressings used (particularly any left in situ), and any deviation from the prescribed procedure. Fix any record labels from the outside packaging of the items used during the procedure on the patient record and add this to the patient's notes.
   To provide a record of the procedure and evidence that any items used have undergone an appropriate sterilization process (DH [21], C; NMC [86], C).